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Mail Drop 521M Fuel Tax Refund Compliance Unit PO Box 2100 Phoenix AZ 85001-2100 Clear 602-712-8727 96-0152A R12/14 USE FUEL VENDOR SUMMARY DETAIL azdot. gov Refund Period Beginning Date Refund Period Ending Date ADOT License Number Company Name ADOT Branch Number Gallons Purchased Gallons Claimed from form 96-0152B Totals round to whole gallons Transfer totals to Use Fuel Vendor Refund Application form 96-0152.

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96 0152a az form is a tax form used in Arizona to report certain income or deductions.

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